Multimodality imaging of bilateral pheochromocytomaA case report


COD: 2396_24_06_2015_ep_5 Categorie: ,

Nunzia Cinzia Paladino, Aoife Lowery, Carole Guérin, David Taïeb, Frédéric Sebag

Ann. Ital. Chir. Published online (EP) 24 June 2015

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INTRODUCTION: Bilateral pheochromocytomas ( PHEO ) are rare, often hereditary and linked to a germline mutationof RET, VHL or SDHx. They also occur sporadically.
PRESENTATION OF CASE: We report a case of a 76 year old female hospitalized for biological investigations followingsymptoms of abdominal discomfort with recurrent hypertensive episodes. The hormonal work up results favoured a dia-gnosis of a PHEO (urinary and plasma metanephrines > 10 times normal). Radiological investigations (CT-MRI): iden-tified bilateral adrenal masses (47 mm in the right adrenal, 26 mm in the left adrenal). Functional imaging with 123I-MIBG scintigraphy showed intense uptake in the right adrenal mass with limited uptake in the left, probably relatedto a fixation of the normal adrenal medulla. Due to the strong suspicion of bilateral PHEO, further imaging with an18F-FDOPA PET was performed. This revealed intense hypermetabolism of the right mass but the left mass had simi-lar metabolism to the liver, thought to be unsuspicious for a PHEO. It was decided to proceed with a laparoscopic rightadrenalectomy. Hormonal investigations performed post-operatively revealed persistently elevated metanephrines. An 18F-FDG PET was performed, revealing an intense hypermetabolic focus in the left adrenal gland. A laparoscopic partialleft adrenalectomy was subsequently performed 6 weeks after the initial right adrenalectomy.
DISCUSSION AND CONCLUSIONS: This case highlights the possibility of false negative results using specific functional ima-ging. In these situations, 18F-FDG PET may be useful. The MRI signal has an indisputable value. Until today, nogermline mutation was found in this patient.